Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study
- 02.03.2024
- Research Article
Erschienen in:
- Verfasst von
- Timi Earl
- Amani Jridi
- Perla C. Thulin
- Meghan Zorn
- Kathleen E. McKee
- Kristin Mitrovich
- Paolo Moretti
- Jumana Alshaikh
- Panagiotis Kassavetis
- Melissa M. Cortez
- Guillaume Lamotte
- Erschienen in
- Clinical Autonomic Research | Ausgabe 1/2024
Abstract
Purpose
We investigated the effect of levodopa on postural blood pressure changes in individuals with Parkinson disease (PD) with (PD+OH) and without neurogenic OH (PD−OH).
Methods
We performed a prospective randomized crossover study with autonomic testing performed ON and OFF levodopa. The primary outcome was the change in systolic blood pressure (SBP) from supine to 70° tilt at 3 min (ΔSBP-3’). Secondary outcomes included indices of baroreflex function and blood pressure and heart rate during tilt.
Results
We enrolled 40 individuals with PD (21 PD+OH, 19 PD−OH), mean age (SD) 73.2 years (7.9), 13 women (32.5%)). There was no difference in age, sex, disease duration, and severity between PD+OH and PD−OH. Mean difference in ΔSBP-3’ ON versus OFF levodopa in the whole study population was − 3.20 mmHg [− 7.36 to 0.96] (p = 0.14). Mean difference in ΔSBP-3’ was − 2.14 mmHg [− 7.55 to 3.28] (p = 0.45) in PD+OH and − 5.14 mmHg [− 11.63 to 1.35] (p = 0.14) in PD−OH. Mean difference in ΔSBP ON versus OFF levodopa was greater at 7 and 10 min (− 7.52 mmHg [− 11.89 to − 3.15], p = 0.002, and − 7.82 mmHg [− 14.02 to − 1.67], p = 0.02 respectively). Levodopa was associated with lower absolute values of blood pressure in both PD+OH and PD−OH and cardiovascular noradrenergic baroreflex impairment.
Conclusion
Levodopa decreases blood pressure in both PD with and without autonomic failure, but it does not cause a greater fall in blood pressure from supine to standing at 3 min. Levodopa-induced baroreflex sympathetic noradrenergic impairment may contribute to lower blood pressure. Lower standing blood pressure with levodopa may increase the risks of fall and syncope.
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- Titel
- Effect of levodopa on postural blood pressure changes in Parkinson disease: a randomized crossover study
- Verfasst von
-
Timi Earl
Amani Jridi
Perla C. Thulin
Meghan Zorn
Kathleen E. McKee
Kristin Mitrovich
Paolo Moretti
Jumana Alshaikh
Panagiotis Kassavetis
Melissa M. Cortez
Guillaume Lamotte
- Publikationsdatum
- 02.03.2024
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
Clinical Autonomic Research / Ausgabe 1/2024
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560 - DOI
- https://doi.org/10.1007/s10286-024-01024-5
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